101
|
Takae S, Lee JR, Mahajan N, Wiweko B, Sukcharoen N, Novero V, Anazodo AC, Gook D, Tzeng CR, Doo AK, Li W, Le CTM, Di W, Chian RC, Kim SH, Suzuki N. Fertility Preservation for Child and Adolescent Cancer Patients in Asian Countries. Front Endocrinol (Lausanne) 2019; 10:655. [PMID: 31681163 PMCID: PMC6804405 DOI: 10.3389/fendo.2019.00655] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/09/2019] [Indexed: 12/31/2022] Open
Abstract
Background: At present, fertility is one of the main concerns of young cancer patients. Following this trend, "fertility preservation (FP)" has been established and has become a new field of reproductive medicine. However, FP for child and adolescent (C-A) cancer patients is still developing, even in advanced countries. The aim of the present study was to assess the barriers to FP for C-A patients by investigating the current status of FP for C-A patients in Asian countries, which just have started FP activities. Method: A questionnaire survey of founding members of the Asian Society for Fertility Preservation (ASFP) was conducted in November 2018. Main findings: Of the 14 countries, 11 country representatives replied to this survey. FP for C-A patients is still developing in Asian countries, even in Australia, Japan, and Korea, which have organizations or academic societies specialized for FP. In all countries that replied to the present survey, the patients can receive embryo cryopreservation (EC), oocyte cryopreservation (OC), and sperm cryopreservation (SC) as FP. Compared with ovarian tissue cryopreservation (OTC), testicular tissue cryopreservation (TTC) is an uncommon FP treatment because of its still extremely experimental status (7 of 11 countries provide it). Most Asian countries can provide FP for C-A patients in terms of medical technology, but most have factors inhibiting to promote FP for C-A patients, due to lack of sufficient experience and an established system promoting FP for C-A patients. "Don't know how to provide FP treatment for C-A" is a major barrier. Also, low recognition in society and among medical staff is still a particularly major issue. There is also a problem with cooperative frameworks with pediatric departments. To achieve high-quality FP for C-A patients, a multidisciplinary approach is vital, but, according to the present study, few paramedical staff can participate in FP for C-A patients in Asia. Only Australia and Korea provide FP information by video and specific resources. Conclusion: The present study demonstrated the developing status of FP for C-A patients in Asian countries. More intensive consideration and discussion are needed to provide FP in Asian societies based on the local cultural and religious needs of patients.
Collapse
Affiliation(s)
- Seido Takae
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
- *Correspondence: Seido Takae
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul, South Korea
| | | | - Budi Wiweko
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
| | - Nares Sukcharoen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bankok, Thailand
| | - Virgilio Novero
- St. Luke's Medical Center, Quezon City, Philippines
- Section of Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Philippines Manila, Manila, Philippines
| | - Antoinette Catherine Anazodo
- Kids Cancer Centre and Sydney Youth Cancer Service, Sydney Children's Hospital, Randwick, NSW, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia
| | - Debra Gook
- Melbourne IVF, Melbourne, VIC, Australia
| | - Chii-Ruey Tzeng
- Division of Infertility, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | | | - Wen Li
- Reproductive Medicine Center, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | | | - Wen Di
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ri-Cheng Chian
- Center for Reproductive Medicine, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
102
|
Fabbri R, Macciocca M, Vicenti R, Paradisi R, Rossi S, Sabattini E, Gazzola A, Seracchioli R. First Italian birth after cryopreserved ovarian tissue transplantation in a patient affected by non-Hodgkin's lymphoma. Int J Hematol Oncol 2018; 7:IJH08. [PMID: 30651967 PMCID: PMC6331756 DOI: 10.2217/ijh-2018-0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/22/2022] Open
Abstract
This case report describes the first Italian live birth obtained by cryopreserved ovarian tissue transplantation in a woman affected by non-Hodgkin's lymphoma. Before anticancer treatments, several fertility preservation options were proposed. At 29 years the patient underwent laparoscopy for ovarian tissue cryopreservation. After treatments she experienced premature ovarian failure (POF) and asked for cryopreserved ovarian tissue transplantation. Before transplantation, ovarian samples were analyzed to assess neoplastic contamination and tissue quality. Two subsequent ovarian tissue transplantations were performed 4 and 7 years after cryopreservation. The follicle-stimulating hormone and luteinizing hormone reduction, estradiol increase and first menstrual cycle appeared 2 months after the second transplantation. The woman conceived spontaneously 5 months after the second transplantation. After 39 weeks of uneventful gestation, a healthy male baby was born. Ovarian tissue cryopreservation, thawing and transplantation successfully restored ovarian function and fertility after tissue storage.
Collapse
Affiliation(s)
- Raffaella Fabbri
- Gynecology & Physiopathology of Human Reproduction Unit, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital of Bologna, Italy.,Gynecology & Physiopathology of Human Reproduction Unit, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital of Bologna, Italy
| | - Maria Macciocca
- Gynecology & Physiopathology of Human Reproduction Unit, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital of Bologna, Italy.,Gynecology & Physiopathology of Human Reproduction Unit, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital of Bologna, Italy
| | - Rossella Vicenti
- Gynecology & Physiopathology of Human Reproduction Unit, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital of Bologna, Italy.,Gynecology & Physiopathology of Human Reproduction Unit, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital of Bologna, Italy
| | - Roberto Paradisi
- Gynecology & Physiopathology of Human Reproduction Unit, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital of Bologna, Italy.,Gynecology & Physiopathology of Human Reproduction Unit, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital of Bologna, Italy
| | - Stefani Rossi
- Department of Women, Child and Urological Diseases, Gynecology & Physiopathology of Human Reproduction Unit, S Orsola-Malpighi Hospital of Bologna, Italy.,Department of Women, Child and Urological Diseases, Gynecology & Physiopathology of Human Reproduction Unit, S Orsola-Malpighi Hospital of Bologna, Italy
| | - Elena Sabattini
- Unit of Hemolymphopathology, Department of Hematology & Oncology, S Orsola-Malpighi University Hospital of Bologna, Italy.,Unit of Hemolymphopathology, Department of Hematology & Oncology, S Orsola-Malpighi University Hospital of Bologna, Italy
| | - Anna Gazzola
- Unit of Hemolymphopathology, Department of Hematology & Oncology, S Orsola-Malpighi University Hospital of Bologna, Italy.,Unit of Hemolymphopathology, Department of Hematology & Oncology, S Orsola-Malpighi University Hospital of Bologna, Italy
| | - Renato Seracchioli
- Gynecology & Physiopathology of Human Reproduction Unit, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital of Bologna, Italy.,Gynecology & Physiopathology of Human Reproduction Unit, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital of Bologna, Italy
| |
Collapse
|
103
|
Ruan X. Chinese Society of Gynecological Endocrinology affiliated to the International Society of Gynecological Endocrinology Guideline for Ovarian Tissue Cryopreservation and Transplantation. Gynecol Endocrinol 2018; 34:1005-1010. [PMID: 30129788 DOI: 10.1080/09513590.2018.1488957] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
In order to promote the standard application of ovarian tissue cryopreservation in China, and to provide effective scientific medical services of fertility preservation for patients, the First Chinese Guideline of Ovarian Tissue Cryopreservation and Transplantation is established according to the agreements between gynecologists, embryologists, oncologists, pediatricians, breast oncologists, hematologists, and experts on Traditional Chinese Medicine (TCM), based on already successful treated cases within Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China, and based on already existing international guidelines on fertility preservation including important publications in this field. The guideline includes selection criteria, evaluation, and indications; SOPs of ovarian tissue removal, transportation, preparation, freezing, and thawing; approaches of ovarian tissue transplantation and follow-up; practical recommendations for ovarian tissue cryopreservation and transplantation including recommendations of the diseases where this method could be available, and treatment of menopausal symptoms during the peri-transplantation period (time between cryopreservation and retransplantation). The aim of this guideline was to be scientific, practical, and operable.
Collapse
Affiliation(s)
- Xiangyan Ruan
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
- b University Women's Hospital of Tuebingen , Tuebingen , Germany
| |
Collapse
|
104
|
Anazodo A, Ataman-Millhouse L, Jayasinghe Y, Woodruff TK. Oncofertility-An emerging discipline rather than a special consideration. Pediatr Blood Cancer 2018; 65:e27297. [PMID: 29972282 PMCID: PMC6150802 DOI: 10.1002/pbc.27297] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023]
Abstract
Originally absent from the oncologist's consult, then placed in a 'quality of life' rubric, oncofertility should now be an essential part of a comprehensive cancer treatment plan in patients of reproductive age, including adolescents and young adults (AYAs). Oncofertility encompasses the endocrine health of the patient, as well as fertility management options. Thus, pubertal transitions in males and females, bone health, and menstrual health are all part of this discipline, enabling practitioners to work in interdisciplinary teams to solve problems in reproductive health. This review provides a summary of the essential considerations required for the assessement of reproductive risk and choice of fertility preservation options as well as considerations for developing oncofertility services for AYAs.
Collapse
Affiliation(s)
- Antoinette Anazodo
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
- School of Women’s and Children’s Hospital, University of New South Wales, Sydney
| | - Lauren Ataman-Millhouse
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yasmin Jayasinghe
- Department of Obstetrics & Gynaecology University of Melbourne Royal Women’s Hospital, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne
| | - Teresa K. Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
105
|
Ruan X, Du J, Korell M, Kong W, Lu D, Jin F, Li Y, Dai Y, Yin C, Yan S, Gu M, Mueck AO. Case report of the first successful cryopreserved ovarian tissue retransplantation in China. Climacteric 2018; 21:613-616. [PMID: 30378441 DOI: 10.1080/13697137.2018.1514005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- X. Ruan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Women's Health, University Women's Hospital, University of Tuebingen, Tuebingen, Germany
| | - J. Du
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - M. Korell
- Department of Obstetrics and Gynecology, Johanna Etienne Krankenhaus, Neuss, Germany
| | - W. Kong
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Fengtai, China
| | - D. Lu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Fengtai, China
| | - F. Jin
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Y. Li
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Y. Dai
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - C. Yin
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - S. Yan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - M. Gu
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - A. O. Mueck
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Women's Health, University Women's Hospital, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
106
|
von Wolff M, Sänger N, Liebenthron J. Is Ovarian Tissue Cryopreservation and Transplantation Still Experimental? It Is a Matter of Female Age and Type of Cancer. J Clin Oncol 2018; 36:JCO1800425. [PMID: 30289731 DOI: 10.1200/jco.18.00425] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Michael von Wolff
- Michael von Wolff, University of Berne, Berne, Switzerland; Nicole Sänger, University Hospital, Johann-Wolfgang Goethe University Frankfurt, Frankfurt, Germany; and Jana Liebenthron, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nicole Sänger
- Michael von Wolff, University of Berne, Berne, Switzerland; Nicole Sänger, University Hospital, Johann-Wolfgang Goethe University Frankfurt, Frankfurt, Germany; and Jana Liebenthron, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jana Liebenthron
- Michael von Wolff, University of Berne, Berne, Switzerland; Nicole Sänger, University Hospital, Johann-Wolfgang Goethe University Frankfurt, Frankfurt, Germany; and Jana Liebenthron, University Hospital Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
107
|
Rios PD, Kniazeva E, Lee HC, Xiao S, Oakes RS, Saito E, Jeruss JS, Shikanov A, Woodruff TK, Shea LD. Retrievable hydrogels for ovarian follicle transplantation and oocyte collection. Biotechnol Bioeng 2018; 115:2075-2086. [PMID: 29704433 PMCID: PMC6045426 DOI: 10.1002/bit.26721] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/03/2018] [Accepted: 04/25/2018] [Indexed: 01/17/2023]
Abstract
Cancer survivorship rates have drastically increased due to improved efficacy of oncologic treatments. Consequently, clinical concerns have shifted from solely focusing on survival to quality of life, with fertility preservation as an important consideration. Among fertility preservation strategies for female patients, ovarian tissue cryopreservation and subsequent reimplantation has been the only clinical option available to cancer survivors with cryopreserved tissue. However, follicle atresia after transplantation and risk of reintroducing malignant cells have prevented this procedure from becoming widely adopted in clinics. Herein, we investigated the encapsulation of ovarian follicles in alginate hydrogels that isolate the graft from the host, yet allows for maturation after transplantation at a heterotopic (i.e., subcutaneous) site, a process we termed in vivo follicle maturation. Survival of multiple follicle populations was confirmed via histology, with the notable development of the antral follicles. Collected oocytes (63%) exhibited polar body extrusion and were fertilized by intracytoplasmic sperm injection and standard in vitro fertilization procedures. Successfully fertilized oocytes developed to the pronucleus (14%), two-cell (36%), and four-cell (7%) stages. Furthermore, ovarian follicles cotransplanted with metastatic breast cancer cells within the hydrogels allowed for retrieval of the follicles, and no mice developed tumors after removal of the implant, confirming that the hydrogel prevented seeding of disease within the host. Collectively, these findings demonstrate a viable option for safe use of potentially cancer-laden ovarian donor tissue for in vivo follicle maturation within a retrievable hydrogel and subsequent oocyte collection. Ultimately, this technology may provide novel options to preserve fertility for young female patients with cancer.
Collapse
Affiliation(s)
- Peter D. Rios
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611
| | - Ekaterina Kniazeva
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611
| | - Hoi Chang Lee
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611
| | - Shuo Xiao
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611
| | - Robert S. Oakes
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Eiji Saito
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Jacqueline S. Jeruss
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
- Department of Surgery, University of Michigan, Ann Arbor, MI 48105
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109
| | - Ariella Shikanov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109
| | - Teresa K. Woodruff
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611
| | - Lonnie D. Shea
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109
| |
Collapse
|
108
|
Lau GA, Schaeffer AJ. Current standing and future directions in pediatric oncofertility: a narrative review. Transl Androl Urol 2018; 7:S276-S282. [PMID: 30159233 PMCID: PMC6087837 DOI: 10.21037/tau.2018.05.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 03/29/2018] [Indexed: 01/15/2023] Open
Abstract
In this narrative review, we discuss the epidemiology and pathophysiology of infertility in childhood and adolescent cancer. We also review the current guidelines and ethical issues related to pediatric oncofertility. Finally, we present recent advances in basic science and translational research in pediatric fertility preservation (FP).
Collapse
Affiliation(s)
- Glen A Lau
- Division of Urology, University of Utah, Salt Lake City, UT, USA
| | | |
Collapse
|
109
|
Fisch B, Abir R. Female fertility preservation: past, present and future. Reproduction 2018; 156:F11-F27. [DOI: 10.1530/rep-17-0483] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/23/2018] [Indexed: 12/19/2022]
Abstract
Anti-cancer therapy, particularly chemotherapy, damages ovarian follicles and promotes ovarian failure. The only pharmacological means for protecting the ovaries from chemotherapy-induced injury is gonadotrophin-releasing hormone agonist, but its efficiency remains controversial; ovarian transposition is used to shield the ovary from radiation when indicated. Until the late 1990s, the only option for fertility preservation and restoration in women with cancer was embryo cryopreservation. The development of other assisted reproductive technologies such as mature oocyte cryopreservation andin vitromaturation of oocytes has contributed to fertility preservation. Treatment regimens to obtain mature oocytes/embryos have been modified to overcome various limitations of conventional ovarian stimulation protocols. In the last decades, several centres have begun cryopreserving ovarian samples containing primordial follicles from young patients before anti-cancer therapy. The first live birth following implantation of cryopreserved-thawed ovarian tissue was reported in 2004; since then, the number has risen to more than 130. Nowadays, ovarian tissue cryopreservation can be combined within vitromaturation and vitrification of oocytes. The use of cryopreserved oocytes eliminates the risk posed by ovarian implantation of reseeding the cancer. Novel methods for enhancing follicular survival after implantation are presently being studied. In addition, researchers are currently investigating agents for ovarian protection. It is expected that the risk of reimplantation of malignant cells with ovarian grafts will be overcome with the putative development of an artificial ovary and an efficient follicle class- and species-dependentin vitrosystem for culturing primordial follicles.
Collapse
|
110
|
Martinez F. Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives. Hum Reprod 2018; 32:1802-1811. [PMID: 29117320 PMCID: PMC5850800 DOI: 10.1093/humrep/dex218] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION What progress has been made in fertility preservation (FP) over the last decade? SUMMARY ANSWER FP techniques have been widely adopted over the last decade and therefore the establishment of international registries on their short- and long-term outcomes is strongly recommended. WHAT IS KNOWN ALREADY FP is a fundamental issue for both males and females whose future fertility may be compromised. Reproductive capacity may be seriously affected by age, different medical conditions and also by treatments, especially those with gonadal toxicity. There is general consensus on the need to provide counselling about currently available FP options to all individuals wishing to preserve their fertility. STUDY DESIGN, SIZE, DURATION An international meeting with representatives from expert scientific societies involved in FP was held in Barcelona, Spain, in June 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Twenty international FP experts belonging to the American Society of Reproductive Medicine, ESHRE and the International Society of Fertility Preservation reviewed the literature up to June 2015 to be discussed at the meeting, and approved the final manuscript. At the time this manuscript was being written, new evidence considered relevant for the debated topics was published, and was consequently included. MAIN RESULTS AND THE ROLE OF CHANCE Several oncological and non-oncological diseases may affect current or future fertility, either caused by the disease itself or the gonadotoxic treatment, and need an adequate FP approach. Women wishing to postpone maternity and transgender individuals before starting hormone therapy or undergoing surgery to remove/alter their reproductive organs should also be counselled accordingly. Embryo and oocyte cryopreservation are first-line FP methods in post-pubertal women. Metaphase II oocyte cryopreservation (vitrification) is the preferred option. Cumulative evidence of restoration of ovarian function and spontaneous pregnancies after ART following orthotopic transplantation of cryopreserved ovarian tissue supports its future consideration as an open clinical application. Semen cryopreservation is the only established method for FP in men. Testicular tissue cryopreservation should be recommended in pre-pubertal boys even though fertility restoration strategies by autotransplantation of cryopreserved testicular tissue have not yet been tested for safe clinical use in humans. The establishment of international registries on the short- and long-term outcomes of FP techniques is strongly recommended. LIMITATIONS, REASONS FOR CAUTION Given the lack of studies in large cohorts or with a randomized design, the level of evidence for most of the evidence reviewed was three or below. WIDER IMPLICATIONS OF THE FINDINGS Further high quality studies are needed to study the long-term outcomes of FP techniques. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Francisca Martinez
- Hospital Universitario Dexeus, Gran Via Carlos III, 71-75, 08208 Barcelona, Spain
| |
Collapse
|
111
|
Dittrich R, Kliesch S, Schüring A, Balcerek M, Baston-Büst DM, Beck R, Beckmann MW, Behringer K, Borgmann-Staudt A, Cremer W, Denzer C, Diemer T, Dorn A, Fehm T, Gaase R, Germeyer A, Geue K, Ghadjar P, Goeckenjan M, Götte M, Guth D, Hauffa BP, Hehr U, Hetzer F, Hirchenhain J, Hoffmann W, Hornemann B, Jantke A, Kentenich H, Kiesel L, Köhn FM, Korell M, Lax S, Liebenthron J, Lux M, Meißner J, Micke O, Nassar N, Nawroth F, Nordhoff V, Ochsendorf F, Oppelt PG, Pelz J, Rau B, Reisch N, Riesenbeck D, Schlatt S, Sender A, Schwab R, Siedentopf F, Thorn P, Wagner S, Wildt L, Wimberger P, Wischmann T, von Wolff M, Lotz L. Fertility Preservation for Patients with Malignant Disease. Guideline of the DGGG, DGU and DGRM (S2k-Level, AWMF Registry No. 015/082, November 2017) - Recommendations and Statements for Girls and Women. Geburtshilfe Frauenheilkd 2018; 78:567-584. [PMID: 29962516 PMCID: PMC6018069 DOI: 10.1055/a-0611-5549] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/15/2018] [Accepted: 04/17/2018] [Indexed: 12/17/2022] Open
Abstract
Aim
The aim of this official guideline published by the German Society of Gynecology and Obstetrics (DGGG) and coordinated with the German Society of Urology (DGU) and the German Society of Reproductive Medicine (DGRM) is to provide consensus-based recommendations, obtained by evaluating the relevant literature, on counseling and fertility preservation for prepubertal girls and boys as well as patients of reproductive age. Statements and recommendations for girls and women are presented below. Statements or recommendations for boys and men are not the focus of this guideline.
Methods
This S2k guideline was developed at the suggestion of the guideline commission of the DGGG, DGU and DGRM and represents the structured consensus of representative members from various professional associations (n = 40).
Recommendations
The guideline provides recommendations on counseling and fertility preservation for women and girls which take account of the patientʼs personal circumstances, the planned oncologic therapy and the individual risk profile as well as the preferred approach for selected tumor entities.
Collapse
Affiliation(s)
- Ralf Dittrich
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Kliesch
- Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinik Münster, Münster, Germany
| | | | - Magdalena Balcerek
- Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Charité Berlin, Berlin, Germany
| | | | | | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Anja Borgmann-Staudt
- Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Charité Berlin, Berlin, Germany
| | | | - Christian Denzer
- Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm, Germany
| | - Thorsten Diemer
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen, Gießen, Germany
| | - Almut Dorn
- Praxis für Gynäkologische Psychosomatik, Hamburg, Germany
| | - Tanja Fehm
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Gaase
- Gemeinschaftspraxis für Frauenheilkunde, Worms, Germany
| | - Ariane Germeyer
- Frauenklinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Kristina Geue
- Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Pirus Ghadjar
- Radioonkologie und Strahlentherapie, Charité Berlin, Berlin, Germany
| | | | - Martin Götte
- Frauenklinik, Universitätsklinikum Münster, Münster, Germany
| | - Dagmar Guth
- Praxis für Frauenheilkunde Plauen, Plauen, Germany
| | | | - Ute Hehr
- Zentrum für Humangenetik, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Franc Hetzer
- Chirurgisches Departement, Spital Linth, Uznach, Switzerland
| | - Jens Hirchenhain
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | - Ludwig Kiesel
- Frauenklinik, Universitätsklinikum Dresden, Dresden, Germany
| | | | - Matthias Korell
- Frauenklinik, Johanna Etienne Klinikum Neuss, Neuss, Germany
| | - Sigurd Lax
- Institut für Pathologie, LKH Graz Süd-West, Graz, Austria
| | - Jana Liebenthron
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Michael Lux
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Meißner
- Hämatologie, Onkologie und Rheumatologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Oliver Micke
- Strahlentherapie und Radioonkologie, Franziskus Hospital Bielefeld, Bielefeld, Germany
| | | | - Frank Nawroth
- Facharzt-Zentrum für Kinderwunsch, Pränatale Medizin, Endokrinologie und Osteologie, amedes MVZ Hamburg GmbH, Hamburg, Germany
| | - Verena Nordhoff
- Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinik Münster, Münster, Germany
| | - Falk Ochsendorf
- Andrologie, Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Patricia G Oppelt
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Pelz
- Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Beate Rau
- Onkologische Chirurgie, Charité Berlin, Berlin, Germany
| | - Nicole Reisch
- Endokrinologie, Universitätsklinikum München, München, Germany
| | | | - Stefan Schlatt
- Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinik Münster, Münster, Germany
| | - Annekathrin Sender
- Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Roxana Schwab
- Frauenklinik, Universitätsklinikum Mainz, Mainz, Germany
| | - Friederike Siedentopf
- Brustzentrum, Martin-Luther-Krankenhaus, Paul Gerhardt Diakonie, Berlin-Wilmersdorf, Germany
| | - Petra Thorn
- Praxis für psychosoziale Kinderwunschberatung, Paar- und Familientherapie, Mörfelden-Walldorf, Germany
| | | | - Ludwig Wildt
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | | | - Tewes Wischmann
- Medizinische Psychologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael von Wolff
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitäts-Spital Bern, Bern, Switzerland
| | - Laura Lotz
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
112
|
Fertility preservation for adolescent and young adult cancer patients in Japan. Obstet Gynecol Sci 2018; 61:443-452. [PMID: 30018898 PMCID: PMC6046357 DOI: 10.5468/ogs.2018.61.4.443] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/24/2017] [Accepted: 12/12/2017] [Indexed: 12/27/2022] Open
Abstract
Adolescent and young adult (AYA) patients are generally defined as being from 15 to 39 years old. For preservation of fertility in AYA cancer patients, the best-known guideline in this field was released by the American Society of Clinical Oncology (ASCO) in 2006. However, the ASCO guideline is not necessarily applicable to Japanese cancer patients. The Japan Society for Fertility Preservation (JSFP) was formed in 2012, and a system and guideline for fertility preservation in Japanese AYA cancer patients plus children was released in July 2017. According to this guideline, patients should receive psychological and social support from health care providers such as doctors, nurses, psychologists, pharmacists, and social workers. In 2013, the American Society for Reproductive Medicine stated that freezing oocytes is a method that has passed beyond the research stage. However, freezing ovarian tissue is still a research procedure. While slow freezing of ovarian tissue is generally performed, rapid freezing (vitrification) is more popular in Japan. We have developed a new closed technique for ovarian tissue cryopreservation. It has been suggested that optical coherence tomography might be applied clinically to measure the true ovarian reserve and localize follicles in patients undergoing ovarian tissue transplantation. Combining gonadotropin-releasing hormone agonist therapy with anticancer agents might be useful for ovarian protection and it is expected that discussion of such combined treatment will continue in the future. This article outlines practical methods of fertility preservation using assisted reproductive techniques for AYA cancer patients in Japan.
Collapse
|
113
|
Maffei S, Galeati G, Pennarossa G, Brevini TAL, Gandolfi F. Extended ex vivo culture of fresh and cryopreserved whole sheep ovaries. Reprod Fertil Dev 2018; 28:1893-1903. [PMID: 26072996 DOI: 10.1071/rd15101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/20/2015] [Indexed: 12/12/2022] Open
Abstract
We describe an original perfusion system for the culture of whole ovine ovaries for up to 4 days. A total of 33 ovaries were divided into six groups: control (n=6), not perfused and fixed; Groups SM72 and SM72-FSH (n=6 each), perfused with a simple medium for 72h with or without FSH; Groups CM96 and CM96-FSH (n=6 each), perfused with a complex medium for 96h with or without FSH; Group CM96-FSH-cryo, (n=3) cryopreserved and perfused for 96h with Group CM96-FSH medium. Depending on the medium used, morphological parameters of cultured ovaries differed from fresh organs after 72 (SM72, SM72-FSH) or 96 (CM96, CM96-FSH) h of perfusion. Oestradiol and progesterone were secreted in all groups but FSH had an effect only on Group CM96-FSH, stimulating continued oestradiol secretion 10 times higher than in all other groups. Morphological parameters and hormone secretion of cryopreserved ovaries were not different from fresh controls. This method enables the culture of whole ovaries for up to 4 days, the time required in vivo for 0.5-mm follicles to grow to 2.2mm and then for these follicles to reach the ovulatory size of 4mm or more. It could be used as a research tool or to complement current techniques for preserving female fertility.
Collapse
Affiliation(s)
- Sara Maffei
- Institute for Genetic and Biomedical Research, National Research Council, Milan, Italy
| | - Giovanna Galeati
- Department of Veterinary Medical Sciences, Università degli Studi di Bologna, Via Tolara di Sopra, 50 40064 Ozzano dell'Emilia, Italy
| | - Georgia Pennarossa
- Laboratory of Biomedical Embryology, Università degli Studi di Milano, Italy
| | - Tiziana A L Brevini
- Laboratory of Biomedical Embryology, Università degli Studi di Milano, Italy
| | - Fulvio Gandolfi
- Present address: Department of Health, Animal Science and Food Safety, Università degli Studi di Milano via Celoria 10, 20133 Milan, Italy
| |
Collapse
|
114
|
Comparison of the Oocyte Quality Derived from Two-Dimensional Follicle Culture Methods and Developmental Competence of In Vitro Grown and Matured Oocytes. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7907092. [PMID: 29850567 PMCID: PMC5904821 DOI: 10.1155/2018/7907092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/30/2018] [Accepted: 02/28/2018] [Indexed: 01/26/2023]
Abstract
In vitro follicle growth (IVFG) is an emerging fertility preservation technique, which can obtain fertilizable oocytes from an in vitro culture system in female. This study aimed to compare efficiency of the most widely used two-dimensional follicle culture methods [with or without oil layer (O+ or O- group)]. Preantral follicles were isolated from mice and randomly assigned. Follicles were cultured for 10 days and cumulus-oocyte complexes harvested 16-18 hours after hCG treatment. Follicle and oocyte growth, hormones in spent medium, meiotic spindle localization, expression of reactive oxygen species (ROS), mitochondrial activity, and gene expression were evaluated. In follicle growth, survival, pseudoantral cavity formation, ovulation, and oocyte maturation were also significantly higher in O+ group than O- group. Hormone production was significantly higher in follicles cultured in O+ than O-. There were no significant differences in mRNA expression related to development. On the other hand, the level of ROS was increased while the mitochondrial activity of in vitro grown matured oocyte was less than in vivo matured oocytes. In conclusion, follicle culture with O+ group appears to be superior to the culture in O- group in terms of follicle growth, development, oocyte growth, maturation, and microorganelles in oocyte.
Collapse
|
115
|
Tang M, Webber K. Fertility and pregnancy in cancer survivors. Obstet Med 2018; 11:110-115. [PMID: 30214475 DOI: 10.1177/1753495x18757816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023] Open
Abstract
Cancer survivors are increasing as improvements in cancer diagnosis and treatment translate to improved outcomes. As cancer survivors in their reproductive years contemplate pregnancy, it is important to understand the impact of cancer and its treatment on fertility and pregnancy outcomes. Cancer treatments such as chemotherapy and radiotherapy can affect patients' fertility, and strategies are available to help preserve the future fertility of survivors. The potential impact of previous cancer diagnoses and treatments on pregnancy and maternal and fetal outcomes needs to be assessed and discussed with survivors, with support from materno-fetal medicine specialists and high-risk antenatal services as needed.
Collapse
Affiliation(s)
- Monica Tang
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| |
Collapse
|
116
|
Chiti MC, Dolmans MM, Lucci CM, Paulini F, Donnez J, Amorim CA. Further insights into the impact of mouse follicle stage on graft outcome in an artificial ovary environment. Mol Hum Reprod 2018; 23:381-392. [PMID: 28333304 DOI: 10.1093/molehr/gax016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/13/2017] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Are mouse preantral follicles differently affected by isolation, encapsulation and/or grafting procedures according to stage? SUMMARY ANSWER Isolated secondary follicles showed superior ability to survive and grow after transplantation, which was not related to a particular effect of the isolation and/or grafting procedure, but rather to their own ability to induce neoangiogenesis. WHAT IS KNOWN ALREADY Isolated and encapsulated mouse preantral follicles can survive (6-27%) and grow (80-100%) in a fibrin matrix with a low concentration of fibrinogen and thrombin (F12.5/T1) after short-term transplantation. STUDY DESIGN, SIZE, DURATION An in vivo experimental model using 20 donor Naval Medical Research Institute (NMRI) mice (6-25 weeks of age) and 14 recipient severe combined immunodeficient (SCID) mice (11-39 weeks of age) was applied. Each NMRI mouse underwent mechanical disruption of both ovaries and isolation of primordial-primary and secondary follicles with ovarian stromal cells, in order to encapsulate them in an F12.5/T1 matrix. Twelve out of 40 fibrin clots were immediately fixed as controls (D0) (10 for histology and 2 for scanning electron microscopy [SEM]) and the others (n = 28) were grafted to the inner part of the peritoneum for 2 (16 fibrin clots) or 7 (12 fibrin clots) days (D2 and D7). PARTICIPANTS/MATERIALS, SETTING, METHODS This study involved the participation of the Gynecology Research Unit (Universitè Catholique de Louvain) and the Physiological Sciences Department (University of Brasília). Specific techniques were used to analyze the follicle recovery rate (hematoxylin-eosin staining), vascularization (CD34) and follicle ultrastructure (transmission electron microscopy [TEM] and SEM). MAIN RESULTS AND THE ROLE OF CHANCE After follicle isolation and encapsulation, a statistically higher percentage of normal follicles was observed in the secondary group (62%) than in the primordial-primary group (47%). Follicle recovery rates were 34% and 62% for primordial-primary and secondary follicles on D2, respectively, and 12% and 42% on D7, confirming that secondary follicles survive better than primordial-primary follicles after grafting. Concerning vascularization, both follicle stages exhibited similar vascularization to that seen in control mouse ovary on D7, but a significantly higher number of vessels and greater vessel surface area were detected in the secondary follicle group. Despite structural differences in fiber density between fibrin clots and ovarian tissue observed by SEM and TEM, preantral follicles appeared to be well encapsulated in the matrix, also showing a normal ultrastructure after grafting. LARGE SCALE DATA Not applicable. LIMITATIONS, REASONS FOR CAUTION As demonstrated by our results during the isolation procedure, we encapsulated a significantly higher number of round structures in the primordial-primary group than in the secondary group, which could partially explain the lower recovery rate of early-stage follicles in our previous study. However, it is not excluded that the physical and mechanical properties of the fibrin matrix may also play a role in follicle survival and growth, so further investigations are needed. WIDER IMPLICATIONS OF THE FINDINGS This research represents one more key step in the creation of the artificial ovary. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from the Fonds National de la Recherche Scientifique de Belgique (FNRS) to C.A. Amorim as a research associate at FRS-FNRS and (grant 5/4/150/5 awarded to M.M. Dolmans), Fonds Spéciaux de Recherche, Fondation St Luc, Foundation Against Cancer, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES-Brazil) (grant #013/14 CAPES/WBI awarded to C.M. Lucci, with F. Paulini receiving a post-doctoral fellowship), and Wallonie-Bruxelles International, and donations from the Ferrero family. None of the authors have any competing interests to declare in relation to the topic.
Collapse
Affiliation(s)
- M C Chiti
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
| | - M M Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium.,Gynecology Department, Cliniques Universitaires Saint-Luc, 1200, Brussels, Belgium
| | - C M Lucci
- Physiological Sciences Department, Institute of Biological Sciences, University of Brasília, Brasília, DFBrazil
| | - F Paulini
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
| | - J Donnez
- Society for Research into Infertility, 1200 Brussels, Belgium
| | - C A Amorim
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
| |
Collapse
|
117
|
Fertility preservation for female cancer patients. Int J Clin Oncol 2018; 24:28-33. [DOI: 10.1007/s10147-018-1252-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/14/2018] [Indexed: 12/12/2022]
|
118
|
Transplantation of frozen-thawed ovarian tissue: an update on worldwide activity published in peer-reviewed papers and on the Danish cohort. J Assist Reprod Genet 2018; 35:561-570. [PMID: 29497953 DOI: 10.1007/s10815-018-1144-2] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 02/19/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of the study is to review all peer-reviewed published reports of women receiving ovarian tissue transplantation (OTT) with frozen/thawed tissue (OTC) with respect to age, diagnosis, transplantation site, fertility outcome, and potential side effects, including data from all women in the Danish program. METHODS A systematic review of the literature was performed in PubMed combined with results from all patients who had received OTT in Denmark up to December 2017. RESULTS OTT has been reported from 21 different countries comprising a total of 360 OTT procedures in 318 women. In nine women, malignancy was diagnosed after OTT; none were considered to be directly caused by the OTT. Despite a potential under reporting of cancer recurrence, there is currently no evidence to suggest that OTT causes reseeding of the original cancer. Renewed ovarian endocrine function was reported in 95% of the women. Half of all children born following OTT resulted from natural conception, and newborns were reported to be healthy except for one neonate with a chromosome anomaly with a family disposition. Women who conceived after OTT were significantly younger than those who failed. CONCLUSION This study found no indications of sufficient numbers of malignant cells present in the ovarian tissue to cause recurrence of cancer after OTT. Further, it is unlikely that OTC affects the well-being of children born. OTC is now an established method of fertility preservation in Denmark with public reimbursement. The current data encourage that women who require gonadotoxic treatment should be offered an individual evaluation considering fertility preservation.
Collapse
|
119
|
Oocyte vitrification versus ovarian cortex transplantation in fertility preservation for adult women undergoing gonadotoxic treatments: a prospective cohort study. Fertil Steril 2018; 109:478-485.e2. [DOI: 10.1016/j.fertnstert.2017.11.018] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 11/20/2022]
|
120
|
Karavani G, Schachter-Safrai N, Chill HH, Mordechai Daniel T, Bauman D, Revel A. Single-Incision Laparoscopic Surgery for Ovarian Tissue Cryopreservation. J Minim Invasive Gynecol 2018; 25:474-479. [DOI: 10.1016/j.jmig.2017.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/22/2022]
|
121
|
In-vitro regulation of primordial follicle activation: challenges for fertility preservation strategies. Reprod Biomed Online 2018; 36:491-499. [PMID: 29503209 DOI: 10.1016/j.rbmo.2018.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 12/20/2022]
Abstract
Ovarian tissue is increasingly being collected from cancer patients and cryopreserved for fertility preservation. While the only available option to restore fertility is autologous transplantation, this treatment is not appropriate for all patients due to the risk of reintroducing cancer cells and causing disease recurrence. Harnessing the full reproductive potential of this tissue to restore fertility requires the development of culture systems that support oocyte development from the primordial follicle stage. While this has been achieved in the mouse, the goal of obtaining oocytes of sufficient quality to support embryo development has not been reached in higher mammals despite decades of effort. In vivo, primordial follicles gradually exit the resting pool, whereas when primordial follicles are placed into culture, global activation of these follicles occurs. Therefore, the addition of a factor(s) that can regulate primordial follicle activation in vitro may be beneficial to the development of culture systems for ovarian tissue from cancer patients. Several factors have been observed to inhibit follicle activation, including anti-Müllerian hormone, stromal-derived factor 1 and members of the c-Jun-N-terminal kinase pathway. This review summarizes the findings from studies of these factors and discusses their potential integration into ovarian tissue culture strategies for fertility preservation.
Collapse
|
122
|
Day JR, David A, Cichon AL, Kulkarni T, Cascalho M, Shikanov A. Immunoisolating poly(ethylene glycol) based capsules support ovarian tissue survival to restore endocrine function. J Biomed Mater Res A 2018; 106:1381-1389. [PMID: 29318744 DOI: 10.1002/jbm.a.36338] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 02/06/2023]
Abstract
A common irreversible adverse effect of life-saving anticancer treatments is loss of gonadal endocrine function and fertility, calling for a need to focus on post-treatment quality of life. Here, we investigated the use of poly(ethylene glycol)-vinyl sulfone (PEG-VS) based capsules to support syngeneic donor ovarian tissue for restoration of endocrine function in mice. We designed a dual immunoisolating capsule (PEG-Dual) by tuning the physical properties of the PEG hydrogels and combining proteolytically degradable and nondegradable layers to meet the numerous requirements for encapsulation and immunoisolation of ovarian tissue, such as nutrient diffusion and tissue expansion. Tuning the components of the PEG-Dual capsule to have similar physical properties allowed for concentric encapsulation. Upon implantation, the PEG-based capsules supported ovarian tissue survival and led to a significant decrease in follicle stimulating hormone levels 60 days postimplantation. Mice that received the implants resumed regular estrous cycle activity and follicle development in the implanted grafts. The PEG-Dual capsule provided an environment conducive for tissue survival, while providing a barrier to the host environment. This study demonstrated for the first time that immunoisolating PEG-VS capsules can support ovarian follicular development resulting in the restoration of ovarian endocrine function and can be applied to future allogeneic studies. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 1381-1389, 2018.
Collapse
Affiliation(s)
- James R Day
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109
| | - Anu David
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109
| | - Alexa L Cichon
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, 48109
| | - Tanay Kulkarni
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109
| | - Marilia Cascalho
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, 48109.,Department of Microbiology & Immunology, University of Michigan, Ann Arbor, Michigan, 48109
| | - Ariella Shikanov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109.,Department of Macromolecular Science & Engineering, University of Michigan, Ann Arbor, Michigan, 48109
| |
Collapse
|
123
|
Mouloungui E, Zver T, Roux C, Amiot C. A protocol to isolate and qualify purified human preantral follicles in cases of acute leukemia, for future clinical applications. J Ovarian Res 2018; 11:4. [PMID: 29304838 PMCID: PMC5756359 DOI: 10.1186/s13048-017-0376-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/26/2017] [Indexed: 12/21/2022] Open
Abstract
Background Autotransplantation of cryopreserved ovarian cortex can be associated with a risk of cancer cell reseeding. This issue could be eliminated by grafting isolated preantral follicles. Collagenase NB6 is an enzyme produced under good manufacturing practices (GMP) in compliance with requirements for tissue engineering and transplantation in humans and thus can be used to isolate preantral follicles from ovarian tissue in the framework of further clinical applications. Multicolor flow cytometry is an effective tool to evaluate the potential contamination of follicular suspensions by leukemic cells. Methods The efficiency of collagenase NB6 was evaluated in comparison to collagenase type IA and Liberase DH, in terms of yield, morphology and viability. A short-term in vitro culture of follicles isolated with collagenase NB6 was conducted for 3 days in a fibrin matrix. A modelization procedure was carried out to detect the presence of leukemic cells in follicular suspensions using multicolor flow cytometry (MFC). Results No statistical differences were found between collagenase NB6, Liberase DH (p = 0.386) and collagenase type IA (p = 0.171) regarding the number of human preantral follicles isolated. The mean diameter of isolated follicles was significantly lower with collagenase NB6 (p < 0.0001). The survival rate of isolated follicles was 93.4% (n = 272) using collagenase NB6 versus 94.9% (n = 198) with Liberase DH and 92.6% (n = 298) using collagenase type IA. Even after 3 days of in vitro culture in a fibrin scaffold, most of the isolated follicles were still alive after using collagenase NB6 (90.7% of viable follicles; n = 339). The rate of isolated Ki67-positive follicles was 29 ± 9.19% before culture and 45 ± 1.41% after 3 days. In 23 out of 24 follicular suspensions analyzed, the detection of leukemic cells by MFC was negative. The purification had no significant impact on follicle viability. Conclusion The isolation and purification of human preantral follicles were performed following good manufacturing practices for cell therapy. Multicolor flow cytometry was able to confirm that final follicular suspensions were free from leukemic cells. This safe isolation technique using collagenase NB6 can be considered for future clinical applications.
Collapse
Affiliation(s)
- Elodie Mouloungui
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France
| | - Tristan Zver
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France.,Department of Reproductive Medicine and Biology, Cryobiology, University Hospital of Besançon, 3 boulevard Fleming, 25000, Besançon Cedex, France
| | - Christophe Roux
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France.,INSERM CIC-1431, University Hospital of Besançon, Clinical Investigation Center in Biotherapy, F-25000, Besançon, France.,Department of Reproductive Medicine and Biology, Cryobiology, University Hospital of Besançon, 3 boulevard Fleming, 25000, Besançon Cedex, France
| | - Clotilde Amiot
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France. .,INSERM CIC-1431, University Hospital of Besançon, Clinical Investigation Center in Biotherapy, F-25000, Besançon, France. .,Department of Reproductive Medicine and Biology, Cryobiology, University Hospital of Besançon, 3 boulevard Fleming, 25000, Besançon Cedex, France.
| |
Collapse
|
124
|
Yasmin E, Balachandren N, Davies MC, Jones GL, Lane S, Mathur R, Webber L, Anderson RA. Fertility preservation for medical reasons in girls and women: British fertility society policy and practice guideline. HUM FERTIL 2018; 21:3-26. [DOI: 10.1080/14647273.2017.1422297] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ephia Yasmin
- Department of Women’s Health, University College London Hospitals, London, UK
| | | | - Melanie C. Davies
- Department of Women’s Health, University College London Hospitals, London, UK
| | - Georgina L. Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Sheila Lane
- Department of Paediatric Oncology and Haematology, Children’s Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Raj Mathur
- Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Lisa Webber
- Department of Women’s Health, University College London Hospitals, London, UK
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
125
|
Chiti MC, Dolmans MM, Mortiaux L, Zhuge F, Ouni E, Shahri PAK, Van Ruymbeke E, Champagne SD, Donnez J, Amorim CA. A novel fibrin-based artificial ovary prototype resembling human ovarian tissue in terms of architecture and rigidity. J Assist Reprod Genet 2018; 35:41-48. [PMID: 29236205 PMCID: PMC5758477 DOI: 10.1007/s10815-017-1091-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/14/2017] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The aim of this study is to optimize fibrin matrix composition in order to mimic human ovarian tissue architecture for human ovarian follicle encapsulation and grafting. METHODS Ultrastructure of fresh human ovarian cortex in age-related women (n = 3) and different fibrin formulations (F12.5/T1, F30/T50, F50/T50, F75/T75), rheology of fibrin matrices and histology of isolated and encapsulated human ovarian follicles in these matrices. RESULTS Fresh human ovarian cortex showed a highly fibrous and structurally inhomogeneous architecture in three age-related patients, but the mean ± SD of fiber thickness (61.3 to 72.4 nm) was comparable between patients. When the fiber thickness of four different fibrin formulations was compared with human ovarian cortex, F50/T50 and F75/T75 showed similar fiber diameters to native tissue, while F12.5/T1 was significantly different (p value < 0.01). In addition, increased concentrations of fibrin exhibited enhanced storage modulus with F50/T50, resembling physiological ovarian rigidity. Excluding F12.5/T1 from further analysis, only three remaining fibrin matrices (F30/T50, F50/T50, F75/T75) were histologically investigated. For this, frozen-thawed fragments of human ovarian tissue collected from 22 patients were used to isolate ovarian follicles and encapsulate them in the three fibrin formulations. All three yielded similar follicle recovery and loss rates soon after encapsulation. Therefore, based on fiber thickness, porosity, and rigidity, we selected F50/T50 as the fibrin formulation that best mimics native tissue. CONCLUSIONS Of all the different fibrin matrix concentrations tested, F50/T50 emerged as the combination of choice in terms of ultrastructure and rigidity, most closely resembling human ovarian cortex.
Collapse
Affiliation(s)
- Maria Costanza Chiti
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
- Gynecology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Lucie Mortiaux
- Institute of Condensed Matter and Nanosciences, Bio and Soft Matter, Université Catholique de Louvain, Croix du Sud 1, 1348 Louvain-la-Neuve, Belgium
| | - Flanco Zhuge
- Institute of Condensed Matter and Nanosciences, Bio and Soft Matter, Université Catholique de Louvain, Croix du Sud 1, 1348 Louvain-la-Neuve, Belgium
| | - Emna Ouni
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
| | - Parinaz Asiabi Kohneh Shahri
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
| | - Evelyne Van Ruymbeke
- Institute of Condensed Matter and Nanosciences, Bio and Soft Matter, Université Catholique de Louvain, Croix du Sud 1, 1348 Louvain-la-Neuve, Belgium
| | - Sophie-Demoustier Champagne
- Institute of Condensed Matter and Nanosciences, Bio and Soft Matter, Université Catholique de Louvain, Croix du Sud 1, 1348 Louvain-la-Neuve, Belgium
| | - Jacques Donnez
- Society for Research into Infertility, Brussels, Belgium
| | - Christiani Andrade Amorim
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
| |
Collapse
|
126
|
Shapira M, Raanani H, Barshack I, Amariglio N, Derech-Haim S, Marciano MN, Schiff E, Orvieto R, Meirow D. First delivery in a leukemia survivor after transplantation of cryopreserved ovarian tissue, evaluated for leukemia cells contamination. Fertil Steril 2018; 109:48-53. [DOI: 10.1016/j.fertnstert.2017.09.001] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/26/2017] [Accepted: 09/01/2017] [Indexed: 11/27/2022]
|
127
|
McDougall RJ, Gillam L, Delany C, Jayasinghe Y. Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven? JOURNAL OF MEDICAL ETHICS 2018; 44:27-31. [PMID: 29084865 PMCID: PMC5749308 DOI: 10.1136/medethics-2016-104042] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/24/2017] [Accepted: 07/11/2017] [Indexed: 05/30/2023]
Abstract
Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. 'Fertility preservation' for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such 'experimental' procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents' decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children's Hospital in Melbourne, Australia.
Collapse
Affiliation(s)
- Rosalind J McDougall
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lynn Gillam
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Clare Delany
- Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
| | - Yasmin Jayasinghe
- Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
128
|
Lee DY, Kim SK, Kim M, Hwang KJ, Kim SH. Fertility preservation for patients with hematologic malignancies: The Korean Society for Fertility Preservation clinical guidelines. Clin Exp Reprod Med 2017; 44:187-192. [PMID: 29376015 PMCID: PMC5783915 DOI: 10.5653/cerm.2017.44.4.187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/14/2017] [Accepted: 03/28/2017] [Indexed: 12/16/2022] Open
Abstract
Although the survival rate of hematologic malignancies in young patients is very high, cytotoxic therapies such as chemotherapy and total body irradiation therapy can significantly reduce a patient's reproductive capacity and cause irreversible infertility. Early ovarian failure also commonly occurs following additional cancer treatment, bone marrow transplantation, or autologous transplantation. Because the risk of early ovarian failure depends on the patient's circumstances, patients with a hematologic malignancy must consult health professionals regarding fertility preservation before undergoing treatments that can potentially damage their ovaries. While it is widely known that early menopause commonly occurs following breast cancer treatment, there is a lack of reliable study results regarding fertility preservation during hematologic malignancy treatment. Therefore, an in-depth discussion between patients and health professionals about the pros and cons of the various options for fertility preservation is necessary. In this study, we review germ cell toxicity, which occurs during the treatment of hematologic malignancies, and propose guidelines for fertility preservation in younger patients with hematologic malignancies.
Collapse
Affiliation(s)
- Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Miran Kim
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Kyung Joo Hwang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
129
|
Masciangelo R, Bosisio C, Donnez J, Amorim CA, Dolmans MM. Safety of ovarian tissue transplantation in patients with borderline ovarian tumors. Hum Reprod 2017; 33:212-219. [DOI: 10.1093/humrep/dex352] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/03/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rossella Masciangelo
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
| | - Chiara Bosisio
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
| | - Jacques Donnez
- Société de Recherche pour l’Infertilité, Avenue Grandchamp 143, 1150 Brussels, Belgium
| | - Christiani A Amorim
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200 Brussels, Belgium
- Département de Gynécologie, Cliniques Universitaires St. Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| |
Collapse
|
130
|
von Wolff M, Germeyer A, Liebenthron J, Korell M, Nawroth F. Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part II: fertility preservation techniques. Arch Gynecol Obstet 2017; 297:257-267. [PMID: 29181578 PMCID: PMC5762782 DOI: 10.1007/s00404-017-4595-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/10/2017] [Indexed: 12/24/2022]
Abstract
Purpose In addition to guidelines focusing on scientific evidence, practical recommendations on fertility preservation are also needed. Methods A selective literature search was performed based on the clinical and scientific experience of the authors. This article (Part II) focuses on fertility preservation techniques. Part I, also published in this journal, provides information on disease prognosis, disease-specific therapy, and risks for loss of fertility. Results Ovarian stimulation including double stimulation and freezing of oocytes is the best-established therapy providing live birth chances in women < 35 years with high ovarian reserve of around 30–40%. Ovarian tissue freezing is especially useful in young women with good ovarian, if spontaneous conception is favoured and if < 1 week until chemotherapy is provided. Data on success rates are still limited, but this further evolving technique will possibly reach similar success rates as ovarian stimulation. GnRH agonists seem to reduce the risk of premature ovarian failure up to 50%; however, the effect is possibly not long-lasting. Ovarian transposition can easily be combined with freezing of ovarian tissue and is the preferred technique before pelvic radiotherapy. Other techniques, such as in vitro maturation, are limited to women with high ovarian reserve and remain less effective. In addition, procedures such as in vitro growth of follicles, etc. are still experimental. Conclusions Fertility preservation in women provides realistic chances of becoming pregnant. The choice of technique needs to be based on the time required, the woman’s age, its risks and efficacy, and the individual preference of the patient.
Collapse
Affiliation(s)
- Michael von Wolff
- Division of Gynaecological Endocrinology and Reproductive Medicine, Medical University of Berne, Berne, Switzerland.
- Division of Gynaecological Endocrinology and Reproductive Medicine, University Women's hospital, Inselspital Bern, Effingerstrasse 102, 3010, Bern, Switzerland.
| | - A Germeyer
- Department of Gynaecological Endocrinology and Fertility Disorders, Medical University of Heidelberg, Heidelberg, Germany
| | - J Liebenthron
- Department of Gynaecological Endocrinology and Reproductive Medicine, Medical University of Bonn, Bonn, Germany
| | - M Korell
- Department of Obstetrics and Gynaecology, Johanna Etienne Hospital of Neuss, Neuss, Germany
| | - F Nawroth
- Centre for Infertility, Prenatal Medicine, Endocrinology and Osteology, Amedes Hamburg, Hamburg, Germany
| |
Collapse
|
131
|
Beckmann MW, Dittrich R, Lotz L, van der Ven K, van der Ven HH, Liebenthron J, Korell M, Frambach T, Sütterlin M, Schwab R, Seitz S, Müller A, von Wolff M, Häberlin F, Henes M, Winkler-Crepaz K, Krüssel JS, Germeyer A, Toth B. Fertility protection: complications of surgery and results of removal and transplantation of ovarian tissue. Reprod Biomed Online 2017; 36:188-196. [PMID: 29198423 DOI: 10.1016/j.rbmo.2017.10.109] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/13/2017] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
Fertility-preserving measures are becoming important for patients receiving oncological treatment. One method involves cryopreservation of ovarian tissue and transplanting it when treatment is completed. We report complications resulting from surgical and fertility medicine, and the results of procedures for the removal and transplantation of ovarian tissue carried out within the FertiProtekt network. A survey using a structured questionnaire was conducted among the FertiProtekt network centres between November 2015 and June 2016. The analysis included surgical techniques used to remove and transplant ovarian tissue, surgical complications and results. Laparoscopic removal and transplantation of ovarian tissue have a low risk of complications. Surgical complications occurred in three of the network's 1373 ovarian tissue removals (n = 1302) and transplantations (n = 71); two complications (0.2%) occurred during removal and one during transplantation. Menstruation resumed in 47 out of 58 women (81%) who underwent ovarian tissue transplantation. Hormonal activity occurred in 63.2% of transplantations with a follow-up of 6 months or over. Sixteen pregnancies occurred in 14 patients, with nine births. The risks and complications of removal and transplantation of ovarian tissue are similar to those of standard laparoscopy. These procedures are becoming standard for fertility protection in cancer patients.
Collapse
Affiliation(s)
- Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center ER-EMN, 91054 Erlangen, Germany.
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center ER-EMN, 91054 Erlangen, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center ER-EMN, 91054 Erlangen, Germany
| | - Karin van der Ven
- Department of Obstetrics and Gynecology, Bonn University Hospital, University of Bonn, 53127 Bonn, Germany
| | - Hans H van der Ven
- Department of Obstetrics and Gynecology, Bonn University Hospital, University of Bonn, 53127 Bonn, Germany
| | - Jana Liebenthron
- Department of Obstetrics and Gynecology, Bonn University Hospital, University of Bonn, 53127 Bonn, Germany
| | - Matthias Korell
- Department of Obstetrics and Gynecology, Johanna-Etienne Hospital Neuss, 41462 Neuss, Germany
| | - Torsten Frambach
- Department of Obstetrics and Gynecology, St. Joseph Hospital Bremen, 28209 Bremen, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, Mannheim University Hospital, Ruprecht-Karls University of Heidelberg, 68167 Mannheim, Germany
| | - Roxana Schwab
- Department of Obstetrics and Gynecology, Freiburg University Hospital, Albert-Ludwigs University of Freiburg, 79106 Freiburg, Germany (now Mainz University Hospital, Johannes Gutenberg University of Mainz, 55122 Mainz, Germany)
| | - Stefan Seitz
- Department of Obstetrics and Gynecology, Caritas- Hospital St. Josef, University of Regensburg, 93053 Regensburg, Germany
| | - Andreas Müller
- Department of Obstetrics and Gynecology, Hospital Karlsruhe, 76133 Karlsruhe, Germany
| | - Michael von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, 3010 Berne, Switzerland
| | - Felix Häberlin
- Department of Obstetrics and Gynaecology, Kantonspital, 9007 St. Gallen, Switzerland
| | - Melanie Henes
- Department of Obstetrics and Gynecology, Tübingen University Hospital, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Katharina Winkler-Crepaz
- Department of Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, 6020 Innsbruck, Austria
| | - Jan S Krüssel
- Department of Obstetrics and Gynecology, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Ariane Germeyer
- Department of Obstetrics and Gynaecology, Heidelberg University Hospital, Ruprecht-Karls University of Heidelberg, 69120 Heidelberg, Germany (B.T. now Department of Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, 6020 Innsbruck, Austria)
| | - Bettina Toth
- Department of Obstetrics and Gynaecology, Heidelberg University Hospital, Ruprecht-Karls University of Heidelberg, 69120 Heidelberg, Germany (B.T. now Department of Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, 6020 Innsbruck, Austria)
| |
Collapse
|
132
|
Kyono K, Hashimoto T, Toya M, Koizumi M, Sasaki C, Shibasaki S, Aono N, Nakamura Y, Obata R, Okuyama N, Ogura Y, Igarashi H. A transportation network for human ovarian tissue is indispensable to success for fertility preservation. J Assist Reprod Genet 2017; 34:1469-1474. [PMID: 28866830 PMCID: PMC5699996 DOI: 10.1007/s10815-017-1022-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/11/2017] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the efficacy of an ovarian tissue transportation network for fertility preservation (FP) for cancer patients in Japan. METHODS PubMed was searched for papers on transportation of human ovarian tissue for FP. We analyzed population, area, number of cancer patients for ovarian tissue cryopreservation (OTC), quality control/assessment and safety, cost of a cryopreservation center for the building for 30 years, and medical fees of cancer patients (operation, cryopreservation, and storage of ovarian tissue). RESULTS More than twenty babies have been born in Denmark and Germany through a transportation system. Up to 400 new patients a year need OTC. The fees for removal, cryopreservation, and storage for 5 years, and transplantation of ovarian tissue are around €5,000, €4,000, and €5,000, respectively. It costs more than €5 million to establish and maintain one cryopreservation center for 30 years. If we have a few cryopreservation centers in Japan, we can cryopreserve 400 patients' ovarian tissue per year by safer slow freezing and maintain quality control/assessment. We need to lighten the patients' burden for easy to use FP by a government subsidy and medical insurance coverage. CONCLUSIONS This model has been termed the Danish model ("the woman stays - the tissue moves"). This is truly patient-centered medicine. We can have maximum effects with the minimum burden. A transportation network like those of Denmark and Germany is the best strategy for FP in Japan. It may be the best system for cancer patients, medical staff, and the Ministry of Health, Labor, and Welfare.
Collapse
Affiliation(s)
- K Kyono
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan.
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan.
| | - T Hashimoto
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - M Toya
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - M Koizumi
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - C Sasaki
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - S Shibasaki
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - N Aono
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - Y Nakamura
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - R Obata
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - N Okuyama
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - Y Ogura
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - H Igarashi
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| |
Collapse
|
133
|
Algarroba GN, Sanfilippo JS, Valli-Pulaski H. Female fertility preservation in the pediatric and adolescent cancer patient population. Best Pract Res Clin Obstet Gynaecol 2017; 48:147-157. [PMID: 29221705 DOI: 10.1016/j.bpobgyn.2017.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/15/2017] [Indexed: 01/26/2023]
Abstract
The 5-year survival rate for childhood cancer is over 80%, thereby increasing the number of young women facing infertility in the future because of the gonadotoxic effects of chemotherapy and radiation. The gonadotoxic effects of childhood cancer treatment vary by the radiation regimen and the chemotherapeutic drugs utilized. Although the American Society of Clinical Oncology guidelines recommend fertility preservation for all patients, there are several barriers and ethical considerations to fertility preservation in the pediatric and adolescent female population. Additionally, the fertility preservation methods for pre- and postpubertal females differ, with only experimental methods available for prepubertal females. We will review the risk of chemotherapy and radiation on female fertility, the approach to fertility preservation in the pediatric and adolescent female population, methods of fertility preservation for both pre- and postpubertal females, barriers to fertility preservation, cost, and psychological and ethical considerations.
Collapse
Affiliation(s)
- Gabriela N Algarroba
- University of Pittsburgh School of Medicine, 3550 Terrace St., Pittsburgh, PA 15213, USA.
| | - Joseph S Sanfilippo
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket St., Suite 5150, Pittsburgh, PA 15213, USA.
| | - Hanna Valli-Pulaski
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, 204 Craft Ave, Pittsburgh, PA 15213, USA.
| |
Collapse
|
134
|
Guenther V, Alkatout I, Junkers W, Bauerschlag D, Maass N, von Otte S. Fertility Preservation in Female Patients with Breast Cancer - a Current Overview. Geburtshilfe Frauenheilkd 2017; 77:1088-1094. [PMID: 29093602 PMCID: PMC5658233 DOI: 10.1055/s-0043-119543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 12/12/2022] Open
Abstract
Many premenopausal patients who develop breast cancer have not yet completed their family planning, so measures of fertility protection to preserve their fertile potential would be beneficial. Polychemotherapy causes irreversible damage to the ovarian follicles – irrespective of whether in a neoadjuvant or adjuvant setting – and this can sometimes result in permanent infertility. Depending on which cytostatic agents are used and on the age-related ovarian reserve of the woman, gonadotoxic risk must be classified as low, moderate or high. Options of fertility preservation include: a) cryopreservation of fertilised or unfertilised oocytes. After ovarian hyperstimulation, mature oocytes are retrieved by transvaginal follicle aspiration, after which they are cryopreserved, either unfertilised or on completion of IVF or ICSI treatment. During b) cryopreservation of ovarian tissue, about 50% of the ovarian cortex of one ovary is resected with the aid of a laparoscopic procedure and cryopreserved. The application of c) GnRH agonists as a medicinal therapy option is an attempt at endocrine ovarian suppression in order to protect oocytes, granulosa cells and theca cells from the cytotoxic effect of chemotherapy.
Collapse
Affiliation(s)
- Veronika Guenther
- Department of Gynaecology and Obstetrics, UKSH Campus Kiel, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Gynaecology and Obstetrics, UKSH Campus Kiel, Kiel, Germany
| | - Wiebe Junkers
- University Fertility Centre, Medical Care Centre, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Dirk Bauerschlag
- Department of Gynaecology and Obstetrics, UKSH Campus Kiel, Kiel, Germany
| | - Nicolai Maass
- Department of Gynaecology and Obstetrics, UKSH Campus Kiel, Kiel, Germany
| | - Soeren von Otte
- University Fertility Centre, Medical Care Centre, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| |
Collapse
|
135
|
Chiti MC, Dolmans MM, Hobeika M, Cernogoraz A, Donnez J, Amorim CA. A modified and tailored human follicle isolation procedure improves follicle recovery and survival. J Ovarian Res 2017; 10:71. [PMID: 29061149 PMCID: PMC5654051 DOI: 10.1186/s13048-017-0366-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/10/2017] [Indexed: 11/23/2022] Open
Abstract
Background Ovarian tissue cryopreservation followed by transplantation after cancer remission is the most commonly applied fertility restoration approach in very young girls and women who require immediate cancer therapy. However, clinicians strongly advise against reimplantation of one’s own ovarian tissue when there is a high risk of recurrence after grafting. For these patients, development of an alternative strategy, namely a transplantable artificial ovary, offers future hope of conceiving. The first essential requirement for an artificial ovary is the set-up of a safe and effective follicle isolation procedure. Despite encouraging results with different variants of this technique, none of them take into the account the physiology and great variability in follicular density inside individual tissue fragments and between different patients. The goal of this study was to improve our previously applied follicle isolation procedure in order to develop a tailored isolation procedure for human follicles according to individual tissue properties. To this end, enzymatic digestion was divided into three time intervals in order to initially recover the first follicles to be isolated, and then further dissociate undigested fragments of tissue containing entrapped follicles. Results After thawing frozen human ovarian tissue using a modified and tailored follicle isolation method, already 35% of follicles were fully isolated and recovered after 30 min of enzymatic digestion. Indeed, this protocol resulted in a higher follicle yield (p < 0.01) and greater numbers of primordial and primary follicles (p < 0.05) than the previous approach. However, no significant difference was found in caspase-3-positive and Ki67-positive staining between the two isolation protocols. In addition, greater follicle quality was demonstrated. When human follicles isolated using the modified protocol were encapsulated in a fibrin matrix with high concentrations of fibrinogen and thrombin and xenografted to a SCID mouse, more follicles were found to be healthy after one week of transplantation than in a previous our study. Conclusions With the modified follicle isolation method, we were able to maximize the number and quality of isolated primordial and primary follicles, and develop a tailored follicle isolation procedure according to individual tissue properties. Moreover, improved follicle survival inside an artificial ovary prototype was detected after one week of xenografting. Electronic supplementary material The online version of this article (10.1186/s13048-017-0366-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Maria Costanza Chiti
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium. .,Gynecology Department, Cliniques Universitaires Saint-Luc, 1200, Brussels, Belgium.
| | - Maria Hobeika
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
| | - Alice Cernogoraz
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
| | - Jacques Donnez
- Society for Research into Infertility, Brussels, Belgium
| | - Christiani Andrade Amorim
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
| |
Collapse
|
136
|
Hashimoto T, Nakamura Y, Obata R, Doshida M, Toya M, Takeuchi T, Kyono K. Effects of fertility preservation in patients with breast cancer: A retrospective two-centers study. Reprod Med Biol 2017; 16:374-379. [PMID: 29259491 PMCID: PMC5715900 DOI: 10.1002/rmb2.12054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/07/2017] [Indexed: 11/12/2022] Open
Abstract
Purpose To assess the efficacy of fertility preservation (FP) and the impact of chemotherapy on the reproductive potential of Japanese patients with breast cancer. Methods Sixty‐two patients with breast cancer visited the authors’ centers from October, 2003 to June, 2015. They were divided into two groups according to the treatment: oocyte or embryo vitrification for FP before cancer treatment (group A) or infertility treatment after cancer treatment (group B). Group B was divided into two subgroups, B1 (no chemotherapy) and B2 (postchemotherapy), in order to analyze the effect of anticancer drugs on ovarian reserves and assisted reproductive technology outcomes. The number of retrieved oocytes, vitrified oocytes or embryos, and pregnancy rates were analyzed and compared: group A compared to group B1 compared to group B2. Results The patients in groups A and B1 underwent egg collection without any chemotherapy. The numbers of collected oocytes and vitrified embryos were significantly higher in groups A and B1 than in group B2. Nearly 50% of the in vitro fertilization patients who underwent an embryo transfer (ET) became pregnant, including two patients in group A who underwent a vitrified‐warmed ET. Among the pregnant women, 70% did not have chemotherapy. Conclusion For patients with breast cancer, FP with unfertilized oocytes or embryos before chemotherapy seems to be promising for achieving higher pregnancy rates, with no risk of minimal residual disease.
Collapse
Affiliation(s)
- Tomoko Hashimoto
- Kyono ART Clinic Takanawa Tokyo Japan.,Kyono ART ClinicSendaiJapan
| | | | | | | | | | | | - Koichi Kyono
- Kyono ART Clinic Takanawa Tokyo Japan.,Kyono ART ClinicSendaiJapan
| |
Collapse
|
137
|
Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P. Advances in fertility preservation of female patients with hematological malignancies. Expert Rev Hematol 2017; 10:951-960. [PMID: 28828900 DOI: 10.1080/17474086.2017.1371009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The most common forms of hematological malignancies that occur in female reproductive years are lymphoma and leukemia. Areas covered: Several aggressive gonadotoxic regimens such as alkylating chemotherapy and total body irradiation are used frequently in treatment of lymphoma and leukemia leading to subsequent iatrogenic premature ovarian failure and fertility loss. In such cases, female fertility preservation options should be offered in advance. Expert commentary: In order to preserve fertility of young women and girls with lymphoma and leukemia, several established, experimental, and debatable options can be offered before starting chemotherapy and radiotherapy. However, each of those female fertility preservation options has both advantages and disadvantages and may not be suitable for all patients. That is why a fertility preservation strategy should be individualized and tailored distinctively for each patient in order to be effective. Artificial human ovary is a novel experimental in vitro technology to produce mature oocytes that could be the safest option to preserve and restore fertility of young women and girls with hematological malignancies especially when other fertility preservation options are not feasible or contraindicated. Further research and studies are needed to improve the results of artificial human ovary and establish it in clinical practice.
Collapse
Affiliation(s)
- Mahmoud Salama
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Vladimir Isachenko
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Evgenia Isachenko
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Gohar Rahimi
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Peter Mallmann
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| |
Collapse
|
138
|
Martinez F. Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives. Fertil Steril 2017; 108:407-415.e11. [PMID: 28739117 DOI: 10.1016/j.fertnstert.2017.05.024] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/19/2017] [Indexed: 12/21/2022]
Abstract
STUDY QUESTION What progress has been made in fertility preservation (FP) over the last decade? SUMMARY ANSWER FP techniques have been widely adopted over the last decade and therefore the establishment of international registries on their short- and long-term outcomes is strongly recommended. WHAT IS KNOWN ALREADY FP is a fundamental issue for both males and females whose future fertility may be compromised. Reproductive capacity may be seriously affected by age, different medical conditions and also by treatments, especially those with gonadal toxicity. There is general consensus on the need to provide counselling about currently available FP options to all individuals wishing to preserve their fertility. STUDY DESIGN, SIZE, DURATION An international meeting with representatives from expert scientific societies involved in FP was held in Barcelona, Spain, in June 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Twenty international FP experts belonging to the American Society of Reproductive Medicine, ESHRE and the International Society of Fertility Preservation reviewed the literature up to June 2015 to be discussed at the meeting, and approved the final manuscript. At the time this manuscript was being written, new evidence considered relevant for the debated topics was published, and was consequently included. MAIN RESULTS AND THE ROLE OF CHANCE Several oncological and non-oncological diseases may affect current or future fertility, either caused by the disease itself or the gonadotoxic treatment, and need an adequate FP approach. Women wishing to postpone maternity and transgender individuals before starting hormone therapy or undergoing surgery to remove/alter their reproductive organs should also be counselled accordingly. Embryo and oocyte cryopreservation are first-line FP methods in postpubertal women. Metaphase II oocyte cryopreservation (vitrification) is the preferred option. Cumulative evidence of restoration of ovarian function and spontaneous pregnancies after ART following orthotopic transplantation of cryopreserved ovarian tissue supports its future consideration as an open clinical application. Semen cryopreservation is the only established method for FP in men. Testicular tissue cryopreservation should be recommended in pre-pubertal boys even though fertility restoration strategies by autotransplantation of cryopreserved testicular tissue have not yet been tested for safe clinical use in humans. The establishment of international registries on the short- and long-term outcomes of FP techniques is strongly recommended. LIMITATIONS, REASONS FOR CAUTION Given the lack of studies in large cohorts or with a randomized design, the level of evidence for most of the evidence reviewed was 3 or below. WIDER IMPLICATIONS OF THE FINDINGS Further high quality studies are needed to study the long-term outcomes of FP techniques. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Francisca Martinez
- Hospital Universitario Dexeus, Gran Via Carlos III, 71-75, 08208, Barcelona, Spain.
| |
Collapse
|
139
|
Validation of an automated technique for ovarian cortex dissociation: isolation of viable ovarian cells and their qualification by multicolor flow cytometry. J Ovarian Res 2017. [PMID: 28645304 PMCID: PMC5481923 DOI: 10.1186/s13048-017-0337-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Ovarian tissue cryopreservation is a technique for fertility preservation addressed to prepubertal girls or to patients for whom no ovarian stimulation is possible before initiation of gonadotoxic treatments. Autotransplantation of frozen-thawed ovarian tissue is the only available option for reuse but presents some limitations: ischemic tissue damages post-transplant and reintroduction of malignant cells in cases of cancer. It is therefore essential to qualify ovarian tissue before autograft on a functional and oncological point of view. Here, we aimed to isolate viable cells from human ovarian cortex in order to obtain an ovarian cell suspension analyzable by multicolor flow cytometry. Methods Ovarian tissue (fresh or frozen-thawed), from patients with polycystic ovarian syndrome (reference tissue) and from patients who underwent ovarian tissue cryopreservation, was used for dissociation with an automated device. Ovarian tissue-dissociated cells were analyzed by multicolor flow cytometry; the cell dissociation yield and viability were assessed. Two automated dissociation protocols (named laboratory and commercial protocols) were compared. Results The effectiveness of the dissociation was not significantly different between reference ovarian tissue (1.58 × 106 ± 0.94 × 106 viable ovarian cells per 100 mg of ovarian cortex, n = 60) and tissue from ovarian tissue cryopreservation (1.70 × 106 ± 1.35 × 106 viable ovarian cells, n = 18). However, the viability was slightly different for fresh ovarian cortex compared to frozen-thawed ovarian cortex whether we used reference tissue (p = 0.022) or tissue from ovarian cryopreservation (p = 0.018). Comparing laboratory and commercial protocols, it appeared that cell yield was similar but cell viability was significantly improved when using the commercial protocol (81.3% ± 12.3% vs 23.9% ± 12.5%). Conclusion Both dissociation protocols allow us to isolate more than one million viable cells per 100 mg of ovarian cortex, but the viability is higher when using the commercial dissociation kit. Ovarian cortex dissociation is a promising tool for human ovarian cell qualification and for ovarian residual disease detection by multicolor flow cytometry.
Collapse
|
140
|
Grèze V, Brugnon F, Chambon F, Halle P, Canis M, Amiot C, Grémeau AS, Pereira B, Yáñez Peralta Y, Tchirkov A, Kanold J. Highly sensitive assessment of neuroblastoma minimal residual disease in ovarian tissue using RT-qPCR-A strategy for improving the safety of fertility restoration. Pediatr Blood Cancer 2017; 64. [PMID: 27734578 DOI: 10.1002/pbc.26287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/08/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ovarian tissue cryopreservation (OTC) is the only option available to preserve fertility in prepubertal females with neuroblastoma (NB), a childhood solid tumor that can spread to the ovaries, with a risk of reintroducing malignant cells after an ovarian graft. PROCEDURE We set out to determine whether the analysis of TH (tyrosine hydroxylase), PHOX2B (paired-like homeobox 2b), and DCX (doublecortin) transcripts using quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) could be used to detect NB contamination in ovarian tissue. Analyses were performed on benign ovarian tissue from 20 healthy women between November 2014 and September 2015 at the University Hospital of Clermont-Ferrand. Pericystic benign ovarian tissues were collected and contaminated with increasing numbers of human NB cells (cell lines IMR-32 and SK-N-SH) before detection using RT-qPCR. RESULTS TH and DCX transcripts were detected in uncontaminated ovarian tissue from all the donors, hampering the detection of small numbers of tumor cells. By contrast, PHOX2B was not detected in any uncontaminated ovarian fragment. PHOX2B levels were significantly increased from 10 NB cells. Our study is the first to evaluate minimal residual disease detection using NB mRNAs in human ovarian tissue. Only PHOX2B was a reliable marker of NB cells contaminating ovarian tissue. CONCLUSIONS These results are encouraging and offer hope in the near future for grafting ovarian tissue in women who survive cancer, whose fertility has been jeopardized by treatment, and who could benefit from OTC without oncological risk.
Collapse
Affiliation(s)
- Victoria Grèze
- CHU Clermont-Ferrand, Service d'Hématologie et d'Oncologie Pédiatrique, Clermont-Ferrand, France.,INSERM-CIC 1405, Unite CRECHE, Clermont-Ferrand, France
| | - Florence Brugnon
- Faculté de Médecine, Université d'Auvergne, Université Clermont 1, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Biologie et médecine de la reproduction, AMP-CECOS, Clermont-Ferrand, France.,Laboratoire Génétique Reproduction et Développement, CNRS 6293-INSERM 1103, Université Clermont 1, UFR Médecine, Clermont-Ferrand, France
| | - Fanny Chambon
- CHU Clermont-Ferrand, Service d'Hématologie et d'Oncologie Pédiatrique, Clermont-Ferrand, France.,INSERM-CIC 1405, Unite CRECHE, Clermont-Ferrand, France
| | - Pascale Halle
- CHU Clermont-Ferrand, Centre de Biothérapie d'Auvergne, Hôpital Estaing, Clermont-Ferrand, France
| | - Michel Canis
- Faculté de Médecine, Université d'Auvergne, Université Clermont 1, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Biologie et médecine de la reproduction, AMP-CECOS, Clermont-Ferrand, France
| | - Clotilde Amiot
- INSERM-CIC 1431, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.,CHU Besançon, Service de Génétique Biologique,-Histologie, Biologie du Développement et de la Reproduction, Cryobiologie-CECOS, Besançon, France
| | - Anne-Sophie Grémeau
- Faculté de Médecine, Université d'Auvergne, Université Clermont 1, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Biologie et médecine de la reproduction, AMP-CECOS, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Unité de Biostatistiques, Délégation à la Recherche Clinique et l'Innovation, Clermont-Ferrand, France
| | - Yania Yáñez Peralta
- Pediatric Oncology Unit, Hospital Universitari i Politècnic La Fe, Avda Fernando Abril Martorell, Valencia, Spain
| | - Andrei Tchirkov
- Faculté de Médecine, Université d'Auvergne, Université Clermont 1, Clermont-Ferrand, France.,CHU Clermont-Ferrand et Centre de Lutte contre le Cancer Jean Perrin, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Service de Cytogénétique Médicale, Clermont-Ferrand, France
| | - Justyna Kanold
- CHU Clermont-Ferrand, Service d'Hématologie et d'Oncologie Pédiatrique, Clermont-Ferrand, France.,INSERM-CIC 1405, Unite CRECHE, Clermont-Ferrand, France.,Faculté de Médecine, Université d'Auvergne, Université Clermont 1, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centre de Biothérapie d'Auvergne, Hôpital Estaing, Clermont-Ferrand, France
| |
Collapse
|
141
|
Soares M, Saussoy P, Maskens M, Reul H, Amorim CA, Donnez J, Dolmans MM. Eliminating malignant cells from cryopreserved ovarian tissue is possible in leukaemia patients. Br J Haematol 2017; 178:231-239. [DOI: 10.1111/bjh.14657] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle Soares
- Pôle de Recherche en Gynécologie; Institut de Recherche Expérimentale et Clinique; Université Catholique de Louvain; Brussels Belgium
- Département de Gynécologie; Cliniques Universitaires St. Luc; Brussels Belgium
| | - Pascale Saussoy
- Département de Biologie Clinique; Cliniques Universitaires St. Luc; Université Catholique de Louvain; Brussels Belgium
| | - Mathilde Maskens
- Pôle de Recherche en Gynécologie; Institut de Recherche Expérimentale et Clinique; Université Catholique de Louvain; Brussels Belgium
| | - Hélène Reul
- Pôle de Recherche en Gynécologie; Institut de Recherche Expérimentale et Clinique; Université Catholique de Louvain; Brussels Belgium
| | - Christiani A. Amorim
- Pôle de Recherche en Gynécologie; Institut de Recherche Expérimentale et Clinique; Université Catholique de Louvain; Brussels Belgium
| | - Jacques Donnez
- Société de Recherche pour l'Infertilité; Brussels Belgium
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie; Institut de Recherche Expérimentale et Clinique; Université Catholique de Louvain; Brussels Belgium
- Département de Gynécologie; Cliniques Universitaires St. Luc; Brussels Belgium
| |
Collapse
|
142
|
Anderson RA, Wallace WHB, Telfer EE. Ovarian tissue cryopreservation for fertility preservation: clinical and research perspectives. Hum Reprod Open 2017; 2017:hox001. [PMID: 30895221 PMCID: PMC6276668 DOI: 10.1093/hropen/hox001] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/23/2017] [Accepted: 02/10/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Small case series have reported successful live births after ovarian tissue cryopreservation and orthotopic transplantation, demonstrating that it can be of value in increasing the chance of successful pregnancy after treatment for cancer and other fertility-impacting diseases in adult women. OBJECTIVE AND RATIONALE This review is intended to set out the current clinical issues in the field of ovarian tissue cryopreservation, and elucidate the status of laboratory studies to address these. SEARCH METHODS We reviewed the English-language literature on ovarian tissue cryopreservation and in vitro maturation (IVM) of ovarian follicles. OUTCOMES Ovarian tissue cryopreservation is increasingly used for fertility preservation and, whilst areas for development remain (optimal patient selection, minimizing risk of contamination by malignant cells and IVM protocols), there are emerging data as to its efficacy. We review the current status of ovarian tissue cryopreservation in girls and young women facing loss of fertility from treatment of cancer and other serious diseases. Increasingly large cohort studies are reporting on success rates from ovarian tissue cryopreservation giving an indication of likely success rates. Patient selection is necessary to ensure the safety and effectiveness of this approach, especially in the very experimental situation of its application to prepubertal girls. There are continuing developments in supporting follicle development in vitro. LIMITATIONS REASONS FOR CAUTION The evidence base consists largely of case series and cohort studies, thus there is the possibility of bias in key outcomes. In vitro development of human ovarian follicles remains some way from clinical application. WIDER IMPLICATIONS OF THE FINDINGS Ovarian tissue cryopreservation is becoming established as a valuable approach to the preservation of fertility in women. Its application in prepubertal girls may be of particular value, as it offers the only approach in this patient group. For both girls and young women, more accurate data are needed on the likelihood of successful childbirth after this procedure and the factors that underpin successful application of this approach, which will lead to its more effective use. STUDY FUNDING/COMPETING INTERESTS The author's work in this field is supported by Medical Research Grant (MRC) grants G0901839 and MR/L00299X/1 and partially undertaken in the MRC Centre for Reproductive Health which is funded by MRC Centre grant MR/N022556/1. The authors declare that there is no conflict of interest that could prejudice the impartiality of the present research.
Collapse
Affiliation(s)
- Richard A Anderson
- Medical Research Council, Centre for Reproductive Health, Queen's Medical Research Institute, 47 Little France Crescent, EdinburghEH16 4TJ, UK
| | - W Hamish B Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, 9 Sciennes Rd, Edinburgh EH9 1LF, UK
| | - Evelyn E Telfer
- Institute of Cell Biology and Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, George Square, Edinburgh EH8 9XD, UK
| |
Collapse
|
143
|
Peters ITA, van der Steen MA, Huisman BW, Hilders CGJM, Smit VTHBM, Vahrmeijer AL, Sier CFM, Trimbos JB, Kuppen PJK. Morphological and phenotypical features of ovarian metastases in breast cancer patients. BMC Cancer 2017; 17:206. [PMID: 28327103 PMCID: PMC5361796 DOI: 10.1186/s12885-017-3191-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/11/2017] [Indexed: 12/23/2022] Open
Abstract
Background Autotransplantation of frozen-thawed ovarian tissue is a method to preserve ovarian function and fertility in patients undergoing gonadotoxic therapy. In oncology patients, the safety cannot yet be guaranteed, since current tumor detection methods can only exclude the presence of malignant cells in ovarian fragments that are not transplanted. We determined the need for a novel detection method by studying the distribution of tumor cells in ovaries from patients with breast cancer. Furthermore, we examined which cell-surface proteins are suitable as a target for non-invasive tumor-specific imaging of ovarian metastases from invasive breast cancer. Methods Using the nationwide database of the Dutch Pathology Registry (PALGA), we identified a cohort of 46 women with primary invasive breast cancer and ovarian metastases. The localization and morphology of ovarian metastases were determined on hematoxylin-and-eosin-stained sections. The following cell-surface markers were immunohistochemically analyzed: E-cadherin, epithelial membrane antigen (EMA), human epidermal growth receptor type 2 (Her2/neu), carcinoembryonic antigen (CEA), αvβ6 integrin and epithelial cell adhesion molecule (EpCAM). Results The majority of ovarian metastases (71%) consisted of a solitary metastasis or multiple distinct nodules separated by uninvolved ovarian tissue, suggesting that ovarian metastases might be overlooked by the current detection approach. Combining the targets E-cadherin, EMA and Her2/neu resulted in nearly 100% detection of ductal ovarian metastases, whereas the combination of EMA, Her2/neu and EpCAM was most suitable to detect lobular ovarian metastases. Conclusions Examination of the actual ovarian transplants is recommended. A combination of targets is most appropriate to detect ovarian metastases by tumor-specific imaging. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3191-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Inge T A Peters
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Bertine W Huisman
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Cornelis F M Sier
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - J Baptist Trimbos
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
144
|
Fibrin in Reproductive Tissue Engineering: A Review on Its Application as a Biomaterial for Fertility Preservation. Ann Biomed Eng 2017; 45:1650-1663. [PMID: 28271306 DOI: 10.1007/s10439-017-1817-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/25/2017] [Indexed: 12/18/2022]
Abstract
In recent years, reproductive medicine has made good use of tissue engineering and regenerative medicine techniques to develop alternatives to restore fertility in cancer patients. For young female cancer patients who cannot undergo any of the currently applied strategies due to the possible presence of malignant cells in their ovaries, the challenge is creating an in vitro or in vivo artificial ovary using carefully selected biomaterials. Thanks to its numerous qualities, fibrin has been widely used as a scaffold material for fertility preservation applications. The goal of this review is to examine and discuss the applications and advantages of this biopolymer for fertility restoration in cancer patients, and consider the main results achieved so far.
Collapse
|
145
|
Jadoul P, Guilmain A, Squifflet J, Luyckx M, Votino R, Wyns C, Dolmans M. Efficacy of ovarian tissue cryopreservation for fertility preservation: lessons learned from 545 cases. Hum Reprod 2017; 32:1046-1054. [DOI: 10.1093/humrep/dex040] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/14/2017] [Indexed: 01/12/2023] Open
|
146
|
Beckmann MW, Dittrich R, Lotz L, Oppelt PG, Findeklee S, Hildebrandt T, Heusinger K, Cupisti S, Müller A. Operative techniques and complications of extraction and transplantation of ovarian tissue: the Erlangen experience. Arch Gynecol Obstet 2017; 295:1033-1039. [PMID: 28197717 DOI: 10.1007/s00404-017-4311-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/27/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Extracting ovarian tissue before oncologic therapy and transplanting it afterwards are increasingly being used to preserve fertility in women. This study describes standardized and safe operative procedures, with few complications, and reports the resulting ovarian function and pregnancy rates. METHODS The standardized operative techniques for removing and transplanting ovarian tissue used at the Erlangen center are: for tissue removal, one-third to half of the tissue from one ovary is excised with scissors, without tissue coagulation; for subsequent transplantation, pieces of ovarian tissue are placed in a retroperitoneal pocket without closure of the pocket. RESULTS Between January 2007 and December 2015, ovarian tissue was extracted in 399 women and transplanted following cancer therapy in 38. No surgical complications were observed within 28 days. To date, there have been ten pregnancies and nine live births after transplantation in seven different women; 26 of the 38 women developed hormonal activity, confirmed by a menstrual cycle or raised serum estradiol levels. CONCLUSIONS The techniques for laparoscopic removal and transplantation of ovarian tissue described here provide a standardized method with a very low risk of complications. The pregnancy rate after ovarian tissue transplantation, currently 15-30%, can be expected to rise further in the near future.
Collapse
Affiliation(s)
- Matthia W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Ralf Dittrich
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
| | - Laura Lotz
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Patricia G Oppelt
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Sebastian Findeklee
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Susanne Cupisti
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Andreas Müller
- Department of Gynecology and Obstetrics, Klinikum Karlsruhe, Karlsruhe, Germany
| |
Collapse
|
147
|
Fertility preservation practices in pediatric and adolescent cancer patients undergoing HSCT in Europe: a population-based survey. Bone Marrow Transplant 2017; 52:1022-1028. [DOI: 10.1038/bmt.2016.363] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 11/26/2016] [Indexed: 12/11/2022]
|
148
|
Préservation de la fertilité chez les adolescents et jeunes adultes traités pour cancer. Bull Cancer 2016; 103:1019-1034. [DOI: 10.1016/j.bulcan.2016.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/08/2016] [Accepted: 10/08/2016] [Indexed: 01/15/2023]
|
149
|
Benedict C, Thom B, Kelvin JF. Fertility preservation and cancer: challenges for adolescent and young adult patients. Curr Opin Support Palliat Care 2016; 10:87-94. [PMID: 26730794 DOI: 10.1097/spc.0000000000000185] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation options and to support them in their reproductive decision-making prior to treatment. RECENT FINDINGS Several barriers prevent fertility from being adequately addressed in the clinical context. Providers' and patients' incomplete or inaccurate understanding of infertility risks exacerbate patients' reproductive concerns. For female patients in particular, making decisions about fertility preservation before treatment often leads to decision conflict, reducing the likelihood of making informed, value-based decisions, and posttreatment regret and distress. Recent empirically based interventions to improve provider training around fertility issues and to support patient decision-making about fertility preservation show promise. SUMMARY Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in fertility preservation options.
Collapse
Affiliation(s)
- Catherine Benedict
- aDepartment of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset bSurvivorship Center, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | | |
Collapse
|
150
|
Kim SY, Kim SK, Lee JR, Woodruff TK. Toward precision medicine for preserving fertility in cancer patients: existing and emerging fertility preservation options for women. J Gynecol Oncol 2016; 27:e22. [PMID: 26768785 PMCID: PMC4717227 DOI: 10.3802/jgo.2016.27.e22] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
As the number of young cancer survivors increases, quality of life after cancer treatment is becoming an ever more important consideration. According to a report from the American Cancer Society, approximately 810,170 women were diagnosed with cancer in 2015 in the United States. Among female cancer survivors, 1 in 250 are of reproductive age. Anticancer therapies can result in infertility or sterility and can have long-term negative effects on bone health, cardiovascular health as a result of reproductive endocrine function. Fertility preservation has been identified by many young patients diagnosed with cancer as second only to survival in terms of importance. The development of fertility preservation technologies aims to help patients diagnosed with cancer to preserve or protect their fertility prior to exposure to chemo- or radiation therapy, thus improving their chances of having a family and enhancing their quality of life as a cancer survivor. Currently, sperm, egg, and embryo banking are standard of care for preserving fertility for reproductive-age cancer patients; ovarian tissue cryopreservation is still considered experimental. Adoption and surrogate may also need to be considered. All patients should receive information about the fertility risks associated with their cancer treatment and the fertility preservation options available in a timely manner, whether or not they decide to ultimately pursue fertility preservation. Because of the ever expanding number of options for treating cancer and preserving fertility, there is now an opportunity to take a precision medicine approach to informing patients about the fertility risks associated with their cancer treatment and the fertility preservation options that are available to them.
Collapse
Affiliation(s)
- So-Youn Kim
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|